DocumentsDate added
Case report:-
T Mathew * *School Of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur , Malaysia, 57000.
Abstract:- Introduction: Functional appliance is an effective way of treating skeletal Class II malocclusion in children and adolescents. A 12-month mandibular advancement protocol with Twin Block appliance has been proved to enhance the condylar growth and to improve the mandibular retrognathism. Objective: The case report documented the treatment of a 12- year- old girl with skeletal class II malocclusion with over jet of 8mm, 100% Deep bite and Angle Class II molar, Class II canine and Class II incisor relationship. Method: The phase I Orthopedic stage treatment was done using Twin Block appliance for 12 months with mandibular advancement of 8mm including trimming of inter-occlusal bite plane of the Twin Block to facilitate the eruption of Mandibular molars. This was followed by a phase II Pre-adjusted Edgewise appliance therapy for finishing and detailing. Result: The treatment objective of normal overjet and overbite, skeletal class I by growth modification, class I molar relation, class I canine relation, class I incisor relation and lip competency were achieved. Conclusion: A stable harmonious occlusion was achieved after 20 months of treatment.
Key Words:- Functional appliances. Angle Class II malocclusion. Pre-adjusted Edgewise appliance.
References:-
1. McÑamara J A. Components of Class II malocclusion in children 8-10 years of age. Angle Orthod. 1981; 51:177-202.
2. Graber T M, Rakosi T, Petrovic A. Dento-facial Orthopedics with Functional Appliances. St Louis, Mo: Mosby; 1997:346-52.
3. Hägg U, Taranger J. Maturation indicators and the pubertal growth spurt. Am J Orthod. 1982;82(4):299-309.
4. Baccetti T, Franchi L, James A, McNamara JA Jr. The cervical vertebral maturation (CVM) method for assessment of optimal treatment timing in dentofacial orthopaedic. Semin Orthod. 2004;11:119-29.
5. Khal HA, Wong RW, Rabie AB. Elimination of hand-wrist radiographs for maturity assessment in children needing orthodontic therapy. Skeletal Radiol. 2008;37(3):195-200. Epub 2007 Oct 3.
6. Hägg U, Pancherz H. Dentofacial orthopaedics in relation to chronological age, growth period and skeletal development. An analysis of 72 male patients with Class II division 1 malocclusion treated with the Herbst appliance. Eur J Orthod. 1988;10(1):169-76.
7. Bakr A, Rabie AB, Al-Kalaly A. Does the degree of advancement during functional appliance therapy matter? Eur J Orthod. 2008;30(3):274-82.
8. Hägg U, Rabie AB, Bendeus M, Wong RW, Wey MC, Du X, et al. Condylar growth and mandibular positioning with stepwise vs maximum advancement. Am J Orthod.
9. Larry C F L, Ricky W K W. Management of severe Class II malocclusion with sequential removable functional and orthodontic appliances: A case for MOrthRCSEd examination Dental Press J Orthod 46.e1 2011 Sept-Oct;16(5):46e.1-11.
10.Shen G, Hagg U, Darendeliler M. Skeletal effects of bite jumping therapy on the mandible— removable vs. fixed functional appliances. Orthod Craniofac Res 2005;8:2-10.
11. Patel HP, Moseley HC, Noar JH. Cephalometric determinants of successful functional appliance therapy. Angle Orthod. 2002;72: 410-17.
Copyright © 2013 Mathew T. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Case report:- Anesthesia
Pravin Sonuji Sapkal1*, Sudhir Chavan2, V A Kurhekar3, Sampda Rajurkar4 & Prerna Nandedkar5.
1Assistant Professor, 2Head of Department, Dept of Anesthesia, 4Assistant Professor Department of PSM, 5Assistant Professor Department of Biochemistry, Government medical college Akola, Maharashtra, India. 3Associate Professor, Dept of Anesthesia, Government medical college, Miraj, Maharashtra, India.
Abstract:- To Study the effect of Hemoglobin Levels on the induction dose of thiopentone. Background: Thiopentone is the most commonly used induction agent. Its fate is intimately related linked to magnitude of its binding protein, which is deranged in anemia, hypoprotienaemia and A: G ratio. Aim: To evaluate the effect of hemoglobin level alone on the induction dose of thiopentone with normal level of protein, albumin and globulin. Setting and Design: Clinical trial to evaluate the possible interaction between hemoglobin levels and induction dose of thiopentone with the normal levels of proteins like albumin and globulin. Methods and Materials: It is the clinical trial conducted on patients of both sexes between the age of 15-50yrs of ASA grade I and II who follows the criteria during the period of Jan 2010 to Sept 2011. Total 80 subjects are selected in the study. Statistical Analysis used: Z test is used to find the significance. SPSS 17 is used for analysis. Result and conclusion: Dose of thiopentone (MID) in cases is less than that of control group. And it is statistically highly significant. MID of thiopentone is larger in higher hemoglobin concentration. Present study suggests that normal patients vary enormously in their response to thiobarbiturates. The dose of thiopentone sodium required for induction of anesthesia is less in patients with low hemoglobin levels. This may be due to anaemic hypoxia increasing the sensitivity of cerebral cell to drugs. Keywords:- Hemoglobin, induction dose, thiopentone.
References:-
1.Evans AT. Manual of Obstratics.7th ed. Philadelphia: Lippincott William and Wilkins; 2007. p. 62.
2.Atkinsons AJ, Abernethy DR, Daniels CE, Dedrick RL.Principal of clinical pharmacology. 2nd ed. London: Elsevier; 2012. p. 84-9.
3.Dundee JW. Thiopentone narcosis in the presence of hepatic dysfunction. Brit. J. Anaestha 1952;24:81-100.
4.Dundee JW, Hassard TH et.al. The induction dose of thiopentone. A method of study and preliminary illustrative results. Anaesthesia, 1982; 37:1176-8.
5.Dundee JW, Hassard TH et.al. The influence of hemoglobin and plasma urea levels on the induction dose of thiopentone. Anaestesia, 1983;38:26-8.
6.Edwards R, Ellis FR et.al. clinical significance of thiopentone and plasma protiens. Brit. J. Anaesth. 1973; 45-891. 7.Malil L, Afzal L, Abraham V. A study to determine the correlation of hemoglobin levels on the induction dose of thiopentone. Ind. J. Anaesth, 1998;42:36-44.
8.Peterson RC, Shideman FE et.al. Prolongation of thiopental anesthasia by anoxia. Fed.Proc,1950;9:307-8.
9.Brodie BB,Marc LC et.al. The fate of thiopental in man and a method for the estimation in biological fluids. J.Phama Exp ther, 1950; 98: 85-7.
Copyright © 2013 Pravin S et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Case report:-
Yadava Jeve* , Aisha Janjua & Najum Qureshi
Birmingham Women's NHS Foundation Trust Metchley Park Road, Edgbaston, Birmingham B15 2TG, United Kingdom.
Abstract:- This is case of secondary post-partum hemorrhage due to uterine arterio-venous malformation (AVM) caused after caesarean section. AVM was treated with Rusch Balloon and selective uterine artery embolization.
Keywords:- Arteriovenous malformation; Rusch Balloon; Uterine Artery Embolization.
References:-
1.Diwan RV, Brennan JN, Selim MA, et al. Sonographic diagnosis of arteriovenous malformation of the uterus and pelvis. J Clin Ultrasound. 1983;11:295–8.
2.Forssman L, Lundberg J, Schersten T. Conservative treatment of uterine arteriovenous fistula. Acta Obstet Gynecol Scand 1982;61(1):85–7.
3.Yang JJ, Xiang Y, Wan XR, Yang XY. Diagnosis and management of uterine arteriovenous fistulas with massive vaginal bleeding. Int J Obstet Gynaecol. 2005;89:114–119.
4.Poppe W, Assche FA, Wilms G, Favril A, Baert A. Pregnancy after transcatheter embolization of a uterine arteriovenous malformation. Am J Obstet Gynecol. 1987;156:1179–80.
5.Vaknin Z, Sadeh-Mefpechkin D, Halperin R, Altshuler A, Amir P, Maymon R. Pregnancy-related uterine arteriovenous malformations: experience from a single medical center. Ultraschall Med. 2011 Dec;32 Suppl 2:E92-9. Epub 2011 May 25.
6.Bagga R, Verma P, Aggarwal N, Suri V, Bapuraj JR, Kalra N. Failed Angiographic Embolization in Uterine Arteriovenous Malformation. Medscape J Med 2008;10:12
7.Kelly SM, Belli AM, Campbell S. Arteriovenous malformation of the uterus associated with secondary postpartum Haemorrage. Ultrasound Obstet Gynecol. 2003 Jun; 21(6):602-5.
8.Salazar GM, Petrozza JC, Walker TG Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies. Tech Vasc Interv Radiol. 2009 Jun; 12(2):139-47.
9.Grivell RM, Reid KM, Mellor A. Uterine arteriovenous malformations: a review of the current literature. Obstet Gynecol Surv. 2005 Nov;60(11):761-7.
10.O'Berien P, Neyastani A, Buckley AR, Chang SD, Legiehn GM. Uterine arteriovenous malformation from diagnosis to treatment. J Ultrasound Med 2006; 25:1387-92.
11.Papadakos N, Wales L, Hayes K, Belli AM, Loftus I, Ray S Post-traumatic pelvic pseudoaneurysm and arterio-venous fistula: combined endovascular and surgical approach Eur J Vasc Endovasc Surg. 2008 Aug;36(2):164-6. Epub 2008 Jun 3.
12.Wang Z, Chen J, Shi H, Zhou K, Sun H, Li X, Pan J, Zhang X, Liu W, Yang N, Jin Z Efficacy and safety of embolization in iatrogenic traumatic uterine vascular malformations. Clin Radiol. 2012 Jun;67(6):541-5. Epub 2012 Jan 18.
Copyright © 2013 Yadava Jeve. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Clinical study:-
Verma Madhurima1, Gupta Ritu 2, Porwal Sanjay K3*, Swarnkar Madhusudan 4 & Porwal Varsha5
1Assistant Professor,2Associate Professor, Department of Obstetrics and Gynaecology, 3Associate Professor, Department of General Surgery,4Assistant Professor, Department of community Medicine, 5Senior Demonstrator, Department of Anatomy, Jhalawar Hospital and Medical College Society, Jhalawar (Rajasthan)- India.
Abstract:- Background: Uterine leiomyoma is a common entity in premenopausal women. Only a subset of women is symptomatic and needs surgical treatment. Objective: To evaluate the clinical presentation, socio-demography, management outcome and its determinants in Rajasthan, India. Methods: This study was carried out at SMS Medical College Jaipur Rajasthan, a tertiary care hospital in Jaipur Rajasthan. Retrospective review of case records of all surgically managed cases of uterine leiomyoma over a period of 18 month done. Five hundred and eight women with uterine leiomyoma seen and managed surgically in Gynaecology Department. Results: Incidence of leiomyoma was 6.8% of gynaecological admission. The commonest presenting complaints were menstrual disorder (60.4%), abdominal pain (44.6%), abdominal lump (6.2%) and infertility (2.1%). The average uterine size at presentation was 6-8weeks (20.4%). The maximum number of cases 406(79.9%) were in age group of 31-50 years. Total abdominal hysterectomy done in (94.8%) cases. Conclusion: Uterine fibroid are commonly seen in premenopausal women and commonly present with menstrual disorders and may be associated with pelvic pain, infertility, pressure symptoms etc. The uterine size range from nonpalpable to 22 weeks pregnancy size. The treatment is abdominal hysterecetomy and myomectomy.
Keywords:- Uterine Leiomyomata, Menstrual disorder, Hysterectomy.
References:-
1. Parker WH. Uterine myomas: management. Fertility and Sterility. 2007;88(2):255–71.
2. Buttran VCJR, Reiter RC. Uterine fibromyomata- etiology, symptomatology and management. Fertility and Sterility. 1981; 4:36–41.
3. Walker CL, Stewart EA. Uterine fibroids: the elephant in the room. Science. 2005;308:1589–92.
4. Evans P, Brunsell S. Uterine fibroid tumours: Diagnosis and treatment. American Family Physcian.2007;75:1503–18.
5. Anate M. Uterine fibroids in Federal medical Centre, Lokoja: a five year review 2002–2006. The Nigerian Clinical Review Journal. 2007 Jan-Feb: 5–12.
6. Ogunniyi SO, Fasubaa OB. Uterine Fibromyoma in Ilesha, Nigeria. Nigerian Medical Practioner.1990;19(6):93–5.
7. Emembolu JO. Uterine fibromyomata; presentation and management in Northern Nigeria.International Journal of Gynecology and Obstetrics. 1987;25:413–6.
8. Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. American Journal of Obstetrics and Gynaecology 2003;188:100–7.
9. Vollenhoven BJ, Lawerence AS, Healy DL. Uterine fibroids: a clinical review. British Journal of Obstetrics and Gynaecology 1990;97:285–98.
10.Omu AE, Ihejerika IJ, Tabowei G. Management of uterine fibroids at UBTH. Tropical Doctor.1984;14:82–5.
11. Briggs ND. Common gynaecological tumours. Tropical Journal of Obstetrics and Gynaecology.1995;12(12):62–71.
12. Lurie S, Piper I, Woliovitch I, Glezerman M. Age- related prevalence of sonographically confirmed uterine myomas. Journal of obstetrics and Gynaecology. 2005;25:42–4.
13. Lethaby A, Vollenhoven B. Fibroids (uterine myomatosis, leiomyomas) American Family Physcian.2005;71:1753–6.
14. Marino JL, Eskenazi B, Warner M, Samuels S, Vercellini P, Gavoni N, et al. Uterine leiomyoma and menstrual cycle characteristics in a population-based cohort study. Human Reproduction.2004;49:2350–5.
15. Sengupta BS, Wynter HM, Matachial L, Halfen A. Myomectomy in infertile Jamaican women Fat. J Gynaecology and Obstetrics. 1978;15:397–402.
16. Rackow BW, Arici A. Fibroids and in-vitro fertilization: which comes first? Current Opinion in Obstetrics and Gynecology. 2005;17:225–31.
17. Bajekal N, Li TC. Fibroids, infertility and pregnancy wastage. Human Reproduction Update.2000;6:614–20.
18. Witherspoon JT. The hormonal origin of uterine fibroid: a hypothesis. American Journal of Cancer.1935;24:402–6.
19. Ezem BU, Otubu JA. Hysterectomy in the Hausa/Fulani population in Nigeria. International journal of Gynecology and Obstetrics. 1981;19:145–7.
20. Cooper NP, Okolo S. Fibroids in pregnancy-common but poorly understood. Obstetric and Gynecological Survey. 2005; 60:132–8.
21. Jonas HS, Masterdon BJ. Giant uterine tumours: case report and review of literature. Obstetrics and Gynecology. 1972;50:25–9.
22. Omu AE, Ehiegiegba EA. Myomectomy: a reappraisal of postoperative performance. Asia and Oceania Journal of Obstetrics and Gynaecology. 1983;9(1):43–8.
23. Akinola OI, Ottun TA, Fabanwo RO, Akinniyi OA. Blateral uterine artery ligation: an effective low technology option in the management of symptomatic uterine fibroids. Tropical Journal of Obstetrics and Gynaecology. 2003;20:4–6.
24. Uterine leiomyomata in South Western Nigeria: a clinical study of presentations and management outcome. Afr Health Sci.2011 June;11(2):271-8. PMCID: PMC 31585150
25. Fibroids and infertility, An updated systemic review and evidence, Pritts E A; fertile steril; 2009-91;1215-23.
Copyright © 2013 Porwal Sanjay K et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Original research article:-Pulmonary Medicine
Gupta Ashish K1 ,Mehmood Tariq2 & Khan Mohd H3*.
1 Senior resident, Department of Pulmonary Medicine, Rural institute of medical sciences & research Safai, Etawa U.P, India.
2 Assistant Professor, Department of Pulmonary Medicine, Motilal Nehru Medical College (MLNMC), Allahabad, U.P, India.
3 Assistant Professor, Department of Community Medicine, Rohilkhand Medical College, Bareilly,(U.P), India.
Abstract:- Background: Both inadequate prescription and non-compliance with antituberculosis drugs have resulted in the emergence of a dreadful known as multi drug resistant (MDR) tuberculosis.
Objective:
1.To find out prevalence of antituberculosis drug resistance pattern in suspected case of drug resistant Tuberculosis.
2. To find out predominant patterns of drug resistance and will useful in provides guidance on appropriate regimes for treatment of MDR tuberculosis.
Study design: Hospital based study. Setting: Department of pulmonary medicine, Motilal Nehru Medical College (MLNMC), Allahabad, (U.P) India. Participants: 52 patients. Sampling: Purposive sampling method. Results: Out of 52 patients 23(44.23 %) were relapse, 22(42.30 %) were treatment failure and 7(13.46 %) were defaulter. Single drug Resistance was in 13 (25.49 %) patients. Single drug resistance to isoniazid in 7(13.7%) patient, Ethambutol 5(9.8%) patient and in streptomycin 1(1.96) patient. 10 (19.6%) patients were two drug resistance. The most common two drug combination pattern was isoniazid and ethambutol in 4(7.84%) patients followed by isoniazid and Pyrazinamide in 2(3.92) patients and in 1(1.96%) patients each of HR, RS, ZS and ES. 11 patients were 3 drug resistance. Most common three drug pattern was HZE and HRS 3(5.9%) each. five (9.8%) patients were 4 and >4 drugs resistance. Most common combination was HRZE in 2 (3.92%). Conclusion: There is an urgent need for timely identification of suspect of drug resistance by early referral for culture and drug sensitivity test for prompt initiation of appropriate treatment to improve outcome as well as to sever the chain of transmission.
Keywords:- Single drug resistance, Multi drug resistance, Defaulter, Treatment failure, Relapse.
References:-
1.Surendra K. Sharma, Alladi Mohan. Tuberculosis 1st Edition 2001. Jaypee Brother Medical Publisher (P) Ltd. New Delhi, India
2.Pabloz-Mendez A, Raviglione MC, Laszle A. Binkin N, Rieder HL, Bustreo F. et al. Global surveillance for anti tuberculosis- drug resistance 1994-1997. N Eng J Med. 1998; 338: 1641-9.
3.Espinal M. Multi drug resistant tuberculosis: basis for the development of an evidence based case management strategy for Multi drug resistant tuberculosis within the WHO DOTS strategy. Proceedings of 1998 meeting and protocol recommendations, Geneva WHO 1999.
4.Espinal M. Raviglione M, Kochi A. Rational DOTS plus for the control of Multi drug resistance International J tuberculosis and lung disease 1999; 3: 561-3.
5.Desiree TB D'souza, Nerges F Mistry et al. High level of multi drug resistant tuberculosis in new and treatment failure patients from the revised national tuberculosis control programme in an urban metropolis (Mumbai) in Western India. BMC Public health 2007;10: 1186/1471 2458-9-211.
6.Lt. Col. RB Deoskar et al. Study of drug resistant pulmonary tuberculosis. MJAFI 2005; 61: 245-8.
7.Dam. T, M. Isa, and M. Bose et al. Drug sensitivity profile of clinical mycobacterium tuberculosis isolates-a retrospective study from a chest disease institute India. Journal of Medical microbiology 2005; 54: 269-71.
8.Saha AR, Agarwal SK, Saha KV. Study of drug resistance in previously treated tuberculosis patient in Gujarat, India (2000-2001). International J. of Tuberculosis and Lung disease 2002; 6 (12):1098-1101.
9.Hanif M, Malik S, Dhingra VK (2006). Acquired drug resistance pattern in tuberculosis cases at the state tuberculosis centre, Delhi, India. Int. J. tuber and lung diseases 2009;13(1): 74-8.
10.Anuradha B et al. Prevalence of drug resistance under the DOTS strategy in Hyderabad. South India, 2001-2003. International Journal of tuberculosis and lung disease 2006 Jan, 10(1): 58-62.
11.Javed A. Malik et al. Study of anti mycobacterium drug resistance in pulmonary tuberculosis in Kashmir, India Jr. for the Practicing Doctor 5 ( 4) :2008-09.
12.Janmeja AK. Raj B. Acquired drug resistance in tuberculosis in Haryana. J assoc. Physician India 1998 Feb, 46(2): 194-8.
13.B. Malhotra et al. Drug susceptibility profile of mycobacterium tuberculosis isolates at Jaipur. India Jr. of Medical microbiology. 2002;20 (2): 76-8.
Copyright © 2013 Gupta Ashish K,Mahmood Tariq & Khan Mohd H. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.